The life and work of Marko Godina: In memory of a pioneer in reconstructive microsurgery

This year on February 7th was the twentieth anniversary of the tragic death of Marko Godina, a genius innovator in the field of reconstructive microsurgery and exceptional plastic surgeon whose name, already a legend before he died, is still spoken with great admiration by world leading plastic and reconstructive surgeons today. His contributions to our specialty, enormous both in number of new ideas and original observations as well as their clarity and clinical importance, were based on unique personal experience of 826 microvascular free tissue transfers to different recipient sites performed in less than seven years period, between 1976. and beginning of 1983.

Marko Godina was born on 15.4.1943. in Ljubljana, Slovenia. His parents, who were fighting in Tito's army against German nazist had to leave him soon after birth, which was conducted in secrecy, because they were wanted by the occupation forces. He lived with several foster families under the name of Stanko Rozman for two years until his parents finally found him. Marko's father, a Slovenian writer, described these events in a book titled ‘When apricot trees were in the bloom’, which became the basis for the television drama made in 1985.

Marko finished Ljubljana's classical grammar school where he studied Latin, Italian, French, German and English. This knowledge was of great help to him in communicating and spreading his remarkable ideas among plastic surgeons around the world. He started with his medical studies at first in Ljubljana but then moved to University of Zagreb School of Medicine, Zagreb, Croatia, where he won a state award for his scientific project on cleft lip. He started working at the University Department of Plastic Surgery and Burns in Ljubljana, Slovenia (which was at that time part of former Yugoslavia) under Professor Derganc in 1971. His first steps in microsurgery were made during his visit to John Cobbett at East Grinstead, UK, in 1972. and Robert Acland, Glasgow, Scotland, in 1973. Apart from completing the fellowship in hand surgery in Louisville, Kentucky, under Harold Kleinert in 1978., he also studied microsurgery from Tord Skoog and D.M. Gramcko. He organised a European course in Hand Surgery in Ljubljana and later on in Sweden with Goran Lindstrom. He established a microsurgical service in Kuwait where he spent almost year and a half altogether on separate occasions. In 1985. Marko Godina was appointed Professor and Chair of Clinic for Plastic Surgery and Burns at Clinical Center Ljubljana, as the youngest surgeon at the time to get such an honour. Marko Godina's life work, presented in his thesis, and partially posthumously published in September issue of 1986 Plastic and Reconstructive Surgery journal, deals with management of complex trauma to extremities with special attention to lower leg compound injuries treated with microvascular free tissue transfer was a result of a unique personal experience of 532 patients who underwent microsurgical reconstruction following trauma. The essence of his work, he was able to successfully demonstrate due to his phenomenal technical skills, lies in combined immediate management including radical cancer-like debridement and immediate free flap coverage of compound leg defects in conjuction with trauma and orthopedic surgeons, therefore introducing so-called emergency free flaps. Godina showed that outcome of complex extremity injuries is much better if the defect is closed with vascularised free tissue transfer within 72 hours from injury than with delayed or late closure. This revolutionary concept against the old secondary healing approach Marko preached throughout the world, from the USA to Australia and many plastic surgeons from abroad came a long way to learn ‘Ljubljana method’ directly from him. In his thesis, Marko made many useful observations regarding flap selection according to his own classification of bone and soft tissue defects as well as proper selection of recipient vessels to the lower leg, timing of microvascular transfer and wound care. He was the first to advocate the preferential use of end-to-side arterial anastomoses in free flap transfers, especially in lower extremity reconstruction so that no part of arterial tree is sacrificed nor viability of the distal part of limb compromised therefore permitting microvascular transfer to a limb with a single functional vessel. It is surprising that many plastic surgeons today don't know that it was actually Marko Godina who performed and reported on the first clinical use of microvascular latissimus dorsi flap transfer in 1978. Furthermore, Godina was the first to describe and perform free lateral arm flap as well as saphenous neurovascular flap. He recommended use of arterial autografts in microvascular surgery, particularly for long arterial defects in replantation or tissue transfer. Marko became world-famous after he performed for the first time ever temporary ectopic implantation of the amputated hand to the axilla to salvage the mutilated upper extremity, which he re-transplanted back to stump two months later (November 1984-January 1985). In spite of his success, Marko Godina stayed a real gentleman whose courtesy, optimism and hard-working energy opened doors anywhere he went. In addition to being a brave and brilliant surgeon, he was an outstanding teacher and a friend to many distinguished plastic surgeons, both at home and around the world. One of those, Professor C. Angrigiani from Argentina who visited Godina at the beginning of 1986., told me an interesting story how Marko was able to organise dining out even at 5 a.m. after they had spent all day and night in the OR. Apart from his surgical carrer, Marko Godina lived an active social life and had many friends among Slovenian writers, musicians and cultural elite. He had two sons and a daughter. On February 7th 1986., Marko was on his way back from Hannover, Germany to Ljubljana but the plane landed at Zagreb airport due to a heavy fog. His wife Vesna was waiting for him there and they drove back towards 130 km distant Ljubljana when it started raining and snowing. At 20.40 h they were both killed in a car accident just 25 km from Ljubljana to the south after they collided with another vehicle that tried to overtook the bus.

In the year following his death, on the initiative of Dr Graham Lister and other distinguished plastic surgeons around the world, a Marko Godina Travelling Fellowship was established annually to provide stipend for a visiting plastic surgery scholar to the centers of his/her choice including Department of Plastic Surgery and Burns in Ljubljana.

It is said that those who are loved by God die young. It is our duty to remember those like him and honour them, for what they have left made the difference.